Determine whether the following
statements about physician orders are true or false.
a. If state regulations and licensure acts permit nurse
practitioners to prescribe and treat patients, they can issue and sign orders
for patients in a Medicare-certified homecare agency.
b. An order issued by a nurse practitioner will be valid if
a physician co-signs it.
c. As of January 1, 2010, a physician must write a paragraph
on the certification and recertification plan of care that provides clinical
justification for management and evaluation of a care plan.
d. A physician’s order is necessary to screen the patient
for depression using the standardized scale incorporated into OASIS-C.
Scroll down for the answers.
Answers to the Homecare Aptitude Test
Here are the answers to the questions about physician
a. False. Even though several states have given prescriptive rights to nurse
practitioners, that right does not carry over into home health care. Medicare statutes for payment and
certification say only a physician can issue and sign orders for home health
care patients receiving services in a Medicare-certified agency.
b. False. There is no rule validating a nurse practitioner’s order if it is
co-signed by a physician. Two signatures
on a legal document imply that one person is either reviewing or co-signing for
the other person. The nurse practitioner
can neither review nor co-sign a physician’s order. Consequently, anyone reviewing this order
would assume that the physician is reviewing or co-signing the nurse’s
order. And that could lead to denials.
It is acceptable for a nurse practitioner to
communicate to the homecare agency an order generated by the physician. She or he is communicating on behalf of the
physician. However, it must be clear
that the order is from the physician and eventually countersigned by him or
A relevant postscript: A Beacon Institute member recently reported
the denial of several claims because a nurse practitioner signed the orders.
c. True. The final
rule to update the payment rate in the Prospective Payment System for 2010
requires a physician to write a narrative statement about the patient’s
clinical needs to justify management and evaluation of a care plan.
d. False. The Patient
Health Questionnaire 2 (PHQ-2) is considered a patient-administered
screen. A clinician can administer this
screen as part of the comprehensive assessment without obtaining a physician’s
Physician certification of orders
is one item in the “Threat Matrix,” on the agenda for the Mastering Medicare in
2010 seminar. If you plan to attend the
Las Vegas seminar on April 12-13, know that special rate for hotel rooms
at the Flamingo Las Vegas expires on March 19. For more details, click on —